Characteristics of secondary oesophageal peristalsis in operated and non-operated patients with chronic gastro-oesophageal reflux disease.

BACKGROUND AND AIMS: Secondary oesophageal peristalsis contributes to oesophageal volume clearance and may be impaired in a significant proportion of patients with chronic gastro-oesophageal reflux disease (GORD). This study aimed to investigate the triggering of secondary peristalsis in chronic GORD patients compared to those previously operated on with anti-reflux surgery.

PATIENTS AND

METHODS

Healthy volunteers, chronic GORD patients with proven oesophagitis and patients successfully operated on with anti-reflux surgery (> 3 years ago) were investigated. Secondary peristalsis was elicited by oesophageal distension by a bolus of air (10 ml) injected rapidly into the mid-portion of the oesophagus. The peristaltic characteristics in the distal oesophagus were assessed by use of stationary manometry.

RESULTS

The primary peristaltic amplitude in the distal third of the oesophagus was significantly higher (P < 0.002) in the non-operated GORD cases than in those recruited for surgery. Furthermore, a difference in the frequency of failed primary peristalsis was revealed (2.1 versus 8.4%) between the non-operated and operated patients. Secondary peristalsis occurred in 65 +/- 13.2% (mean +/- SE) of the healthy subjects on stimulation, which was a higher figure than in the GORD patients. In patients investigated after successful anti-reflux surgery, a secondary peristaltic wave was elicited in only 26 +/- 7.2% of the attempts, which was significantly lower than the 46 +/- 7.7% seen in non-operated GORD patients (P < 0.05). A direct comparison between motor characteristics of primary and secondary peristalsis revealed that the latter amplitudes were significantly lower both in the non-operated and in the operated cases (P < 0.005).

CONCLUSIONS

The triggering of secondary peristalsis seems to be impaired in chronic GORD patients. Investigating similar patients > 3 years after successful anti-reflux surgery revealed an even lower prevalence of secondary peristaltic waves, implying persistence of the abnormality after surgery and consistent with other evidence that GORD is associated with a primary defect in oesophageal motor function.